Support tools for evidence-informed health Policymaking (STP) 17: Dealing with insufficient research evidence*_Chinese Journal of Evidence-Based Medicine

Authors：

Andrew D Oxman ¹ , John N Lavis ² , Atle Fretheim ³ , Simon Lewin ⁴

1. Norwegian Knowledge Centre for the Health Services;2. Centre for Health Economics and Policy Analysis;3. Norwegian Knowledge Centre for the Health Services;4. Norwegian Knowledge Centre for the Health Services;

Corresponding author：

Keywords：

DOI：

10.7507/1672-2531.20100442

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本文拟解决证据不足情况下的决策问题。决策者通常没有充足的证据来确定某卫生政策或项目方案会带来哪些影响，但他们仍必须做出决策。当没有充分证据确定实施方案效果时，我们建议考虑以下4 个问题：①是否有该方案效果的系统评价？② 是否将不确定性证据误解为该方案无效的证据？③ 尽管缺乏证据，是否能对该项决策充满信心？④ 所选方案是否会产生潜在危害或无效或价无所值？

Citation： Andrew D Oxman,John N Lavis,Atle Fretheim,Simon Lewin. Support tools for evidence-informed health Policymaking (STP) 17: Dealing with insufficient research evidence*. Chinese Journal of Evidence-Based Medicine, 2010, 10(5): 534-538. doi: 10.7507/1672-2531.20100442 Copy

1.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2.	Grobler LA, Marais BJ, Mabunda S, et al. Interventions for increasing the proportion of health professionals practising in underserved communities. Cochrane Database Syst Rev, 2009, 1:CD005314.
3.	Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy, 2009, 7(Suppl 1): S7.
4.	Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1):S8.
5.	Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
6.	Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of costeffective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372: 928-939.
7.	Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
8.	Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 3. Setting priorities for supporting evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S3.
9.	Alderson P, Chalmers I. Survey of claims of no effect in abstracts of Cochrane reviews. BMJ, 2003, 326: 475.
10.	Centers for Disease Control (CDC). Surgeon General’s advisory on the use of salicylates and Reye syndrome. MMWR Morb Mortal Wkly Rep, 1982, 31: 289-290.
11.	Chalmers I. If evidence-informed policy works in practice, does it matter if it doesn’t work in theory? Evidence & Policy, 2005, 1(2): 227-242.
12.	Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
13.	Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Syst Rev, 2002, 1: CD002847.
14.	Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000127.
15.	Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000128.
16.	Villar J, Carroli G, Khan-Neelofur D, et al. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev, 2001, 4: CD000934.
17.	Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev, 2005, 1: CD000196.
18.	Liberati A, Moja L, Moschetti I, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Intern Emerg Med, 2006, 1: 243-245.
19.	Farquhar C, Marjoribanks J, Lethaby A, et al. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev, 2009, 2:CD004143.
20.	Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database Syst Rev, 2007, 2: CD005434.
21.	Guyatt GH, DiCenso A, Farewell V, et al. Randomized trials versus observational studies in adolescent pregnancy prevention. J Clin Epidemiol, 2000, 53:167-74.
22.	Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev, 2007, 4: CD003343.
23.	Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
24.	Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
25.	Oxman AD, Fretheim A. An overview of research on the effects of resultsbased financing. Report Nr 16-2008 2008 [http://www. kunnskapssen teret.no/Publikasjoner/3219.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
26.	Lagarde M, Palmer N. The impact of contracting out on health outcomes and use of health services in low and middleincome countries. Cochrane Database Syst Rev, 2009, 4: CD008133.
27.	Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med, 2007, 100:453-60.
28.	Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Rapport nr. 1- 2008 2008 [http://www.kunnskapssenteret.no/Publikasjoner/ 469.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
29.	Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
30.	Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
31.	UK Cabinet Office. Modernising government: presented to parliament by the prime minister and the minister for the Cabinet Office by command of Her Majesty. Cm 4310 1999 [http://www.archive. official-docu ments.co.uk/document/cm43/4310/4310-00.htm]. London: Stationary Office.
32.	Macintyre S, Chalmers I, Horton R, et al. Using evidence to inform health policy: case study. BMJ, 2001, 322: 222-225.

1. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). Introduction. Health Res Policy Syst, 2009, 7(Suppl 1): I1.
2. Grobler LA, Marais BJ, Mabunda S, et al. Interventions for increasing the proportion of health professionals practising in underserved communities. Cochrane Database Syst Rev, 2009, 1:CD005314.
3. Lavis JN, Oxman AD, Grimshaw J, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 7. Finding systematic reviews. Health Res Policy, 2009, 7(Suppl 1): S7.
4. Lewin S, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 8. Deciding how much confidence to place in a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1):S8.
5. Chopra M, Munro S, Lavis JN, et al. Effects of policy options for human resources for health: an analysis of systematic reviews. Lancet, 2008, 371: 668-674.
6. Lewin S, Lavis JN, Oxman AD, et al. Supporting the delivery of costeffective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews. Lancet, 2008, 372: 928-939.
7. Oxman AD, Schunemann HJ, Fretheim A. Improving the use of research evidence in guideline development: 8. Synthesis and presentation of evidence. Health Res Policy Syst, 2006, 4: 20.
8. Lavis JN, Oxman AD, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 3. Setting priorities for supporting evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S3.
9. Alderson P, Chalmers I. Survey of claims of no effect in abstracts of Cochrane reviews. BMJ, 2003, 326: 475.
10. Centers for Disease Control (CDC). Surgeon General’s advisory on the use of salicylates and Reye syndrome. MMWR Morb Mortal Wkly Rep, 1982, 31: 289-290.
11. Chalmers I. If evidence-informed policy works in practice, does it matter if it doesn’t work in theory? Evidence & Policy, 2005, 1(2): 227-242.
12. Oxman AD, Lavis JN, Lewin S, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 1. What is evidence-informed policymaking. Health Res Policy Syst, 2009, 7(Suppl 1): S1.
13. Hahn S, Kim S, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhea in children. Cochrane Database Syst Rev, 2002, 1: CD002847.
14. Duley L, Henderson-Smart D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000127.
15. Duley L, Henderson-Smart D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev, 2003, 4: CD000128.
16. Villar J, Carroli G, Khan-Neelofur D, et al. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev, 2001, 4: CD000934.
17. Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev, 2005, 1: CD000196.
18. Liberati A, Moja L, Moschetti I, et al. Human albumin solution for resuscitation and volume expansion in critically ill patients. Intern Emerg Med, 2006, 1: 243-245.
19. Farquhar C, Marjoribanks J, Lethaby A, et al. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev, 2009, 2:CD004143.
20. Enayati AA, Hemingway J, Garner P. Electronic mosquito repellents for preventing mosquito bites and malaria infection. Cochrane Database Syst Rev, 2007, 2: CD005434.
21. Guyatt GH, DiCenso A, Farewell V, et al. Randomized trials versus observational studies in adolescent pregnancy prevention. J Clin Epidemiol, 2000, 53:167-74.
22. Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev, 2007, 4: CD003343.
23. Austvoll-Dahlgren A, Aaserud M, Vist G, et al. Pharmaceutical policies: effects of cap and co-payment on rational drug use. Cochrane Database Syst Rev, 2008, 1: CD007017.
24. Devereaux PJ, Choi PT, Lacchetti C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ, 2002, 166: 1399-1406.
25. Oxman AD, Fretheim A. An overview of research on the effects of resultsbased financing. Report Nr 16-2008 2008 [http://www. kunnskapssen teret.no/Publikasjoner/3219.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
26. Lagarde M, Palmer N. The impact of contracting out on health outcomes and use of health services in low and middleincome countries. Cochrane Database Syst Rev, 2009, 4: CD008133.
27. Chalkidou K, Hoy A, Littlejohns P. Making a decision to wait for more evidence: when the National Institute for Health and Clinical Excellence recommends a technology only in the context of research. J R Soc Med, 2007, 100:453-60.
28. Moynihan R, Oxman A, Lavis JN, et al. Evidence-Informed Health Policy: Using Research to Make Health Systems Healthier. Rapport nr. 1- 2008 2008 [http://www.kunnskapssenteret.no/Publikasjoner/ 469.cms]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten.
29. Fretheim A, Oxman AD, Lavis JN, et al. SUPPORT Tools for evidenceinformed health Policymaking (STP). 18. Planning monitoring and evaluation of policies. Health Res Policy Syst, 2009, 7(Suppl 1): S18.
30. Lavis JN, Oxman AD, Souza NM, et al. SUPPORT Tools for evidence- informed health Policymaking (STP). 9. Assessing the applicability of the findings of a systematic review. Health Res Policy Syst, 2009, 7(Suppl 1): S9.
31. UK Cabinet Office. Modernising government: presented to parliament by the prime minister and the minister for the Cabinet Office by command of Her Majesty. Cm 4310 1999 [http://www.archive. official-docu ments.co.uk/document/cm43/4310/4310-00.htm]. London: Stationary Office.
32. Macintyre S, Chalmers I, Horton R, et al. Using evidence to inform health policy: case study. BMJ, 2001, 322: 222-225.

Chinese Journal of Evidence-Based Medicine

Support tools for evidence-informed health Policymaking (STP) 17: Dealing with insufficient research evidence*

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